Spring 2017

IN THIS ISSUE

Program Updates

The Emily Program's Adolescent Intensive Day Program (AIDP) opened at our St. Louis Park, MN location this month. The highly structured program enables us to meet the needs of adolescents and families struggling with eating disorders. To find out more or make a referral, contact us at 1-888-364-5977.

Upcoming Continuing Education Events

Interested in free CEUs and other continuing education opportunities hosted by The Emily Program? Check out all of our upcoming events here. Here's what we have coming up soon:

June 26, Berkeley, CA:Neurobiology of Eating Disorders Informs Early Support in Treatment.Details and registration here.

June 27, Sacramento, CA:Neurobiology of Eating Disorders Informs Early Support in Treatment. Details and registration here.

July 12, Beachwood, OH.Eating Disorder Are All About Food—Or Are They?Details and registration here.

A Closer Look: Co-occurring Eating Disorder/Substance Use Disorder

Eating disorders (EDs) and substance use disorders (SUDs) frequently co-occur.1, 2, 3 This is a major cause for concern because people struggling with both conditions typically demonstrate worse ED symptoms and poorer outcomes, including increased medical complications, longer recovery times, and higher relapse rates than those with ED alone.4, 5, 6, 7

Prevalence varies based on the type of ED, type of SUD, and population studied, but an estimated range of 17-46% of those diagnosed with an eating disorder also struggle with alcohol or other drugs.4In adolescents with ED, SUD is 20-40% more likely than in peers without ED.8

SUDs do not co-occur equally among every type of eating disorder. SUDs are particularly prevalent in conjunction with bulimia/binge eating symptoms, and many more individuals diagnosed with bulimia, binge eating, Other Specified Feeding or Eating Disorders (OSFED) and anorexia (binge eating/purging type) experience the co-occurrence than those diagnosed with anorexia (restrictive type).9

Why are eating disorders and substance use disorder often connected?

The etiology of this co-occurring condition is appears to be multifaceted. Research is ongoing, but it is clear that there are several intertwined factors contributing to ED/SUD. Pearlstein (2002)10 cited four major theories:

Addictions model: This is the idea that similarities of symptoms of both disorders, including shared biopsychosocial factors like the interplay of genes, personality traits and cultural influences, may be causing the co-occurrence. Cooper (1989)11 proposed this theory, suggesting that ED and SUD share four typical characteristics: a) Uncontrollable self-destructive behavior b) Initial denial of the extent of the problem and future consequences 3) Deterioration until there is intervention 4) Family involvement, especially early family dysfunction.

Genetic and family heritability:Many researchers have looked at heritability as a possible cause of ED/SUD.10,11Research has shown that ED and SUD, as separate disorders, can be transmitted genetically, but not cross-transmitted (e.g. if a mother has SUD, it doesn't appear to be more likely that her daughter will have ED).12 This suggests ED and SUD are not manifestations of the same core disorder.

Biological model: This model focuses on the physical effects that ED and SUD share. Evidence suggests that the shared desire to misuse food and substances may be due to an inherently heightened sensitivity to such rewards.13 Both EDs and SUDs are also affected by the dopaminergic system10, 14 Additionally, EDs and SUDs often share physical symptoms, including weight loss, appetite fluctuations, irregular heart rate, muscle weakness, anxiety, and vomiting.

Personality traits and temperamental vulnerabilities model: This model suggests that there are certain personality traits that may make a person more vulnerable to both EDs and SUDs. For example, impulsivity and novelty seeking, which are typically associated with binge eating/purging behaviors, also appear to be associated with ED/SUD co-occurrence.9

Although directionality of ED/SUD co-occurrence is not clearly understood—SUDs can develop before, during or after an ED—studies suggest that one may increase vulnerability to the other. Research shows it is more likely that EDs will influence SUDs than the other way around.15 One theory is that those with EDs may be more likely to use substances because food deprivation alters dopamine in the brain, creating a hyperresponsiveness to novel environmental stimuli. Another theory is that substance use can also cause appetite suppression, which can trigger an ED.9

Other associations

There are several factors that often occur alongside ED/SUD, and may be related. One potential mediating factor is Attention Deficit Hyperactivity Disorder (ADHD). Studies have reported co-morbidities among ADHD, EDs, and SUDs.16, 17, 18 The strongest associations are seen between ADHD and binge eating.16, 18Researchers have also identified abuse, trauma, and post-traumatic stress disorder (PTSD) as associated issues.15, 19, 20 Others have hypothesized that impulsivity and emotional instablility are likely core mediators.21, 22

Identification and Treatment

If left untreated, both EDs and SUDs have high mortality rates,15 and they are particularly dangerous when they co-occur.23

The good news is that co-occurring eating disorder/substance use disorder is highly treatable. Treatment that addresses both EDs and SUDs in an integrated way hold promise to reduce symptoms. Studies show that concurrent treatment for eating disorders and substance use disorder, especially when caught early, is most effective.4, 24 If one condition is identified, it is wise to screen for the other as well.

The Emily Program's Integrated Eating Disorder/Substance Use Disorder program is focused on addressing EDs and SUDs together to achieve the best possible outcome. The personalized, evidence-based program offers substance use assessment, treatment planning, skills-based group therapy, therapeutic meals, medical and psychiatric management, nutrition counseling, care management, family education and support services, and access to mutual peer support, 12-step meetings, and partnerships with sober facilities. To learn more or make a referral, call 1-888-364-5977.

Highlights from the Blog

Join Our Team!

The Emily Program is growing! We are currently recruiting for caring and compassionate professionals to join our team and work at The Emily Program's Minnesota outpatient offices and residential facilities. Our team members enjoy the opportunity for professional and personal growth while working with world-renowned eating disorder experts to deliver individualized care, advocate for social change, and develop innovative treatments. If you are interested in discussing these opportunities further, please give us a call at 651-645-5323 ext. 1634, email This email address is being protected from spambots. You need JavaScript enabled to view it. or visit our careers page